When does spotting from the Depo (medroxyprogesterone) shot typically stop?

Spotting from Depo Shot: Timeline and Management

Spotting from the Depo-Provera (medroxyprogesterone acetate) shot typically decreases with continued use, with many women experiencing amenorrhea after approximately one year of use. 1

Bleeding Pattern Timeline

The bleeding patterns with Depo-Provera follow a predictable course for most women:

• First 3 months: Irregular spotting and light bleeding is very common
• 3-6 months: Bleeding patterns may begin to stabilize for some women
• 6-12 months: Progressive decrease in bleeding episodes
• By 12 months: Approximately 57% of women develop amenorrhea 2

Factors Affecting Bleeding Patterns

Several factors influence how quickly spotting resolves:

• Duration of use: The longer Depo-Provera is used, the more likely bleeding irregularities will improve
• Individual response: Significant variation exists between women
• Consistency of use: Regular injections every 12 weeks help stabilize bleeding patterns

Management of Persistent Spotting

If spotting persists and is bothersome, the CDC recommends the following approach 1:

1. Rule out other causes:

   • Pregnancy
   • Sexually transmitted infections
   • Pathologic uterine conditions (fibroids, polyps)
   • Medication interactions

2. Treatment options for bothersome spotting:

   • NSAIDs for short-term treatment (5-7 days)
   • If medically eligible, hormonal treatment with low-dose COCs or estrogen for short-term treatment (10-20 days)

What to Expect Long-Term

With continued Depo-Provera use:

• Irregular bleeding: Most common in first 2 years of use 3
• Amenorrhea: Becomes the predominant pattern after 3+ years of use 3
• Effectiveness: Remains highly effective (>99%) regardless of bleeding pattern 1

Important Counseling Points

1. Pre-treatment counseling is essential: Women should be informed about potential bleeding changes before starting Depo-Provera 1

2. Reassurance: Bleeding irregularities are generally not harmful and often improve with continued use 1

3. Follow-up: Women experiencing troublesome bleeding should seek medical advice rather than waiting for their next scheduled injection 4

4. Alternative methods: If bleeding irregularities persist and are unacceptable, consider discussing alternative contraceptive methods 1

Pitfalls to Avoid

• Discontinuation due to early bleeding changes: Many women discontinue after just one injection due to irregular bleeding (26% in one study) 5. Proper counseling about expected patterns may improve continuation rates.

• Assuming pathology: While irregular bleeding is expected with Depo-Provera, clinicians should still rule out other causes when patterns change abruptly.

• Missing follow-up: Approximately 23% of discontinuations are due to missed appointments rather than side effects 5.

By understanding the expected timeline for spotting to resolve and implementing appropriate management strategies when needed, both providers and patients can better navigate this common side effect of Depo-Provera.